Provider Demographics
NPI:1801868872
Name:SMITH, DAVID JOSEPH (DO)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JOSEPH
Last Name:SMITH
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:197 MCCLEARY RD.
Mailing Address - Street 2:DEPT OF VETERANS AFFAIRS EXCELSIOR SPRINGS CBOC
Mailing Address - City:EXCELSIOR SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64024
Mailing Address - Country:US
Mailing Address - Phone:816-922-2970
Mailing Address - Fax:816-637-2480
Practice Address - Street 1:197 MCCLEARY RD.
Practice Address - Street 2:DEPT OF VETERANS AFFAIRS EXCELSIOR SPRINGS CBOC
Practice Address - City:EXCELSIOR SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64024
Practice Address - Country:US
Practice Address - Phone:816-922-2970
Practice Address - Fax:816-637-2480
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2012-04-03
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Provider Licenses
StateLicense IDTaxonomies
MODO106805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO243752300Medicaid
24462057OtherBDBS OF KC INDIVIDUAL #
24462057OtherBDBS OF KC INDIVIDUAL #
G68214Medicare UPIN